Many patients with persistent depression following stroke or transient ischemic attack (TIA) are not receiving the treatment they need, a study suggested.

Action Points

This study found that patients following stroke or transient ischemic attack (TIA) had depression scores that were similar to each other and higher than the general population at both 3 and 12 months following their event.

Note that the majority of patients in both categories did not receive antidepressants, although data on nonpharmacologic depression treatments were not available.

Many patients with persistent depression following stroke or transient ischemic attack (TIA) are not receiving the treatment they need, a study suggested.

Of the patients with stroke and TIA, 9.2% and 7.6%, respectively, had depression at both 3 and 12 months after the event, according to Nada El Husseini, MD, of Duke University Medical Center, and colleagues.

Among those patients with persistent depression, 67.9% of those with stroke and 70% of those with TIA were not using antidepressants at either time point, suggesting undertreatment, the researchers reported online in Stroke: Journal of the American Heart Association.

"Systematic evaluation for depression in patients with stroke or TIA may improve detection and treatment of this condition," the authors wrote.

El Husseini and colleagues performed a secondary analysis of the prospective Adherence Evaluation After Ischemic Stroke Longitudinal (AVAIL) study. Depression was defined as a score of 10 or higher (out of 24) on the Patient Health Questionnaire-8 (PHQ-8).

The current analysis included 1,450 adult patients with ischemic stroke and 397 with TIA who were treated at hospitals participating in the Get With The Guidelines-Stroke program.

There were no differences between patients with stroke and TIA in the rates of depression at 3 months (17.9% versus 14.3%, P=0.09) and 12 months (16.4% versus 12.8%, P=0.08). The rates were higher than those seen in the general population in the Behavioral Risk Factor Surveillance Survey (9%).

The relatively constant rate of depression throughout the first year following an event "argues against the hypothesis that the increased risk of depression is limited to the first few months after a cerebrovascular event," according to the researchers.

"In light of the higher frequency of depression at 3 and 12 months, screening for depression appears to be warranted in the first year after stroke or TIA at both time points," they wrote.

The rates of newly identified depression from 3 to 12 months and of persistent depression were similar between patients with stroke and TIA, and there were no differences in the use of antidepressants at any point during the study.

"Some of the subjects with 'depression' in this study may not have needed treatment with antidepressants, because a PHQ-8 score of [10 or higher] reflects 'current depression,' which includes major depression, other depressive disorders, depressed mood, or anhedonia," the researchers wrote. "However, it is very likely that those who were characterized as persistently depressed may have had clinically significant depression that warranted treatment."

But, they added, "Other nonpharmacological treatments for depression such as cognitive behavioral therapy were not captured in this study, thus possibly overestimating the frequency of 'undertreatment.'"

The authors acknowledged some limitations of the study, including some differences between the patients who were included and those who were excluded, such as ability to complete the PHQ-8 instrument; the use of self-report to assess antidepressant use; the lack of information on pre-stroke depression; and the lack of a baseline assessment of stroke severity.

El Husseini was fully supported and two co-authors were partially supported by an American Stroke Association-Bugher Foundation Stroke Prevention Research Center award. The AVAIL project was supported by unrestricted funds from Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership and conducted through collaboration with the American Heart Association and the "Get With The Guidelines-Stroke" program. AVAIL analyses were also supported in part by the Agency for Healthcare Research and Quality.

El Husseini reported having no conflicts of interest. Her co-authors reported relationships with the Critical Care Research and Practice, the National Institutes of Health, Allergan, Pfizer, Boehringer Ingelheim, Merck, Bristol-Myers Squibb, Abbott, the Agency for Healthcare Research and Quality, the Department of Veterans Affairs, the Foundation for Informed Medical Decision Making, the Department of Defense, and the Bristol-Myers Squibb-Sanofi Joint Partnership.

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